Understanding Bell's Palsy treatment & recovery
Experiencing sudden facial weakness or paralysis can be alarming, and if you've been diagnosed with Bell's Palsy, you are likely seeking answers and effective treatment options. Read on to learn about the challenges this condition presents, and how to support your recovery through evidence-based approaches and facial neuromuscular retraining.
What is Bell's Palsy?
Bell’s Palsy occurs where there is a sudden weakness or paralysis of one side of the face. It is named after the surgeon Sir Charles Bell, who discovered that severing the seventh cranial nerve (CNVII or facial nerve) causes facial paralysis. Bell’s Palsy is believed to be caused by inflammation or compression of the facial nerve, and it is the most common cause of acute facial paralysis.
The facial nerve controls the muscles of the face, tear glands, taste sensation, and a small muscle in the ear. While the exact cause is often unknown, Bell’s Palsy is thought to be triggered by viral infections (e.g. herpes simplex, herpes zoster, cytomegalovirus, or Epstein-Barr). It may be associated with reduced immune system function and stress. It is more common in people with diabetes, pregnancy (especially in the third trimester) and in people over the age of 70.
The onset of Bell’s Palsy is usually rapid, with symptoms often reaching a peak within 48 to 72 hours. Symptoms can range from mild weakness to complete paralysis on one side of your face. This can make it difficult to smile, close your eye, chew, drink, or speak clearly.
Medical management: Your first step
If you suspect Bell's Palsy, it is crucial to seek medical attention right away. Your doctor may prescribe medications to help with the inflammation and potentially speed up recovery.
Corticosteroids: These anti-inflammatory drugs, such as prednisone, are often prescribed to reduce swelling around the facial nerve. They are most effective when started within 72 hours of symptom onset.
Antiviral Medications: In some cases, antiviral drugs may be prescribed, though their effectiveness in Bell's Palsy is still debated.
Eye Care: Because Bell's Palsy can prevent you from fully closing your eye, protecting your eye from dryness and irritation is vital. Your doctor may recommend artificial tears, eye drops or ointment, taping, and/or an eye patch, especially at night, to prevent dryness and protect your cornea.
Recovery from Bell’s Palsy
The time it takes for the nerve to recover depends on the extent of the damage to the nerve. Recovery is seen as early as 2 to 3 weeks from the onset of the paralysis. The average recovery period is 6 to 12 weeks, however some patients can recover faster or slower. Studies have shown that over 70-80% of people with Bell’s Palsy make a full recovery. In the remaining 20-30% of cases, the nerve damage is more severe and ongoing symptoms may remain - this includes residual weakness and synkinesis.
Physiotherapy for Bell’s Palsy
While medical management addresses the acute inflammation, physiotherapy can optimize your long-term recovery from Bell's Palsy. A physiotherapist with expertise in facial neuromuscular retraining and can guide you through each stage of the recovery process (flaccid, paretic and synkinetic stage).
After facial paralysis due to Bell's Palsy, careful and specific re-education can improve your facial movements and expressions as your nerve regains function. Improper or aggressive exercises can actually hinder recovery or lead to unwanted long-term complications. This is where the specialized knowledge of a physiotherapist can help.
Stages of recovery and how physiotherapy helps
Bell's Palsy recovery typically progresses through different stages, and physiotherapy interventions are tailored to each phase.
Acute/Flaccid Stage (first 1-3 weeks)
What's happening: In this initial stage, you'll experience the most significant weakness or paralysis. There is no conduction between the brain and facial muscles. The facial muscles are flaccid (loose) and unresponsive. During this phase we do not recommend exercises - by increasing effort in trying to make muscles move, you will increase the strength of the unaffected side only. This can lead to an imbalance between the two sides of your face.
Physiotherapy Focus: The primary goal is to provide education about what to expect and how to support your recovery.
Education: Teaching you about the condition, what to expect, and how to protect your eye.
Gentle Massage: Instructing you on gentle self-massage techniques to maintain tissue suppleness and prevent stiffness.
Avoidance of Overuse: Crucially, we emphasize avoiding attempts at strong, forced movements, which can lead to synkinesis later on.
Subacute/Paretic Stage: Early recovery (weeks 3-6 to 3 months)
What's happening: During this stage there is some conduction between the brain and facial muscles but it is not complete. There is partial recovery of movement. You might start to notice the first subtle twitches or hints of movement returning to your face. This is a very exciting and critical stage.
Physiotherapy Focus: Our goal shifts to facilitating coordinated and natural movement patterns, while preventing abnormal muscle activity.
Gentle, Targeted Exercises: We will introduce very gentle, specific exercises to re-educate individual muscle groups. This is not about "working out" your face, but rather "waking up" the nerve-muscle connection.
Neuromuscular Retraining: Your physiotherapist will guide you through precise movements to help your brain relearn how to control your facial muscles independently and symmetrically. This involves focusing on quality of movement over quantity.
Relaxation Techniques: As movement returns, sometimes patients inadvertently create tension in other facial muscles. We will teach you relaxation techniques to promote natural, fluid movements.
Chronic/Synkinesis Stage (months 3+ to years)
What's happening: For some individuals, as the nerve regenerates it can miswire, leading to a condition called synkinesis. Synkinesis is the involuntary co-contraction of face muscles. This means that when you try to move one part of your face, another part also moves unintentionally (e.g. when you smile, your eye closes). You might also experience facial tightness or spasms. In this stage, your face becomes overactive.
Physiotherapy Focus: This stage requires highly specialized and patient-specific interventions.
Advanced Neuromuscular Retraining: We will use advanced techniques to re-educate the nerve pathways, helping to reduce synkinesis and improve facial symmetry. This might involve selective movement control exercises or inhibition techniques.
Massage and Stretching: This helps to address any tightness or contractures that may have developed.
Addressing Pain and Spasms: If you are experiencing discomfort, we will implement strategies to alleviate pain and manage spasms.
What to AVOID: Electrical Stimulation & Acupuncture
While it might seem intuitive to try to "stimulate" the muscles, we strongly advise against electrical stimulation and acupuncture for Bell's Palsy.
Electrical Stimulation: While widely used in the past, current research suggests that electrical stimulation can actually be detrimental in Bell's Palsy. It can over-stimulate the already compromised nerve and potentially lead to synkinesis and abnormal muscle patterns, making recovery more challenging. The goal should instead be to encourage natural nerve regeneration, not to force muscle contractions.
Acupuncture: While acupuncture can be beneficial for other conditions, there is no strong evidence to support its effectiveness in improving facial nerve function in Bell's Palsy. In some cases, improper needling could potentially exacerbate the condition or cause nerve irritation.
Your journey to a balanced smile
Recovering from Bell's Palsy takes time and dedication. At Vestibular Health, our experienced therapists are here to support you every step of the way. Through personalized facial neuromuscular retraining, we aim to help you regain natural facial movement, reduce complications like synkinesis, and ultimately help you achieve a confident and comfortable smile again.
If you are living with Bell's Palsy and are looking for expert guidance, we are committed to helping you navigate your path to recovery. Our clinic is located in Toronto, and we offer virtual care throughout Ontario, Canada.